3. INTRODUCTION
Failure to thrive (FTT) is a chronic, potentially life threatening
disorder of infants and children who fail to gain and may even lose
weight. Children are considered as failing to thrive when their rate of
growth does not meet the expected growth rate for a child of their
age. More specifically, the term characterized those whose weight is
below the 3rd percentile on an appropriate growth chart.
4.
5. The deviation from a normal growth channel is actually more descriptive of what is
happening to an individual than a decrease in the actual amount of weight. Any
infant or child at the fifth percentile should alert the caregiver that a problem exists.
If the condition progresses, the undernourished child may become irritable and/or
apathetic and may not reach typical developmental markers such as sitting up,
walking, and talking at the usual ages.
6. DEFINITION
FTT is a term used to describe inadequate growth or the inability to maintain
growth in childhood.Attained growth• Weight<3rd percentile on standard growth
chart.• Weight for height<5th percentile on standard growth chart.• Weight 20% or
more below ideal weight for height.Rate of growth• Less than 20g/day from birth to
3 months of age.• Less than 15g/day from 3 months to 6 months of age.• Fall off
from previously established growth curve.• Downward crossing of >2 major
percentiles.
8. ORGANIC
• Occurs when there is underlying medical cause like:
• Premature birth.
• Maternal smoking, alcohol use or illicit drugs during pregnancy.
• Mechanical problems present.
• Unexplained poor appetites that are unrelated to mechanical problems.
• Inadequate intake also can result from metabolic abnormalities.
• Poor absorption of food, inability of the body to use absorbed nutrients or
increased loss of nutrients.
9. INORGANIC
Due to causes other than medical cause
• Poor feeding skills on the part of the parent
• Dysfunctional family interactions
• Difficult parent-child interactions
• Lack of social support
• Lack of parenting preparation
• Family dysfunction, such as abuse or divorce
• Child neglect
• Emotional deprivation
11. CAUSES OF FTT
1• Inadequate caloric intake
2• Inadequate absorption
3• Increased caloric requirement
4•Excessive loss of calories
5• Altered growth potential or regulation
12. 1. INADEQUATE CALORIC INTAKE
• CR Incorrect formula preparation
• Neglect
• Excessive juice consumption
• Poverty
• Behavioral problem affecting eating
• Non-availability of food
• Misperceptions about diet and feeding practices
• Errors in formula reconstitution
13. • Dysfunctional parent-child interaction, child abuse and neglect
• Behavioral feeding problem
• Mechanical problems with sucking, swallowing and feeding
• Primary neurological diseases
• Chronic systemic disease resulting in anorexia, food refusal and
neurological problems
18. CLINICAL FEATURES
• Height, weight, and head circumference do not match standard growth charts
• Weight is lower than 3rd percentile
• Growth may have slowed or stopped after a previously established growth curve
• Physical skills such as rolling over, sitting, standing and walking decreased
• Mental and social skills decreased
• Secondary sexual characteristics delayed in adolescents.
22. HISTORY TAKING
• PRENATAL (INTRANATAL)
• LABOUR, DELIVERY, AND NEONATAL EVENTS
• MEDICAL HISTORY OF CHILD
• SOCIAL HISTORY
• NUTRITIONAL HISTORY
23. EXAMINATION & TESTS
• Physical examination
• Denver Developmental Screening Test
• A growth chart outlining all types of growth
• Complete blood count (CBC)
• Electrolyte balance
• Hemoglobin electrophoresis
• Hormone studies, including thyroid function tests
• X-rays to determine bone age
• Urinalysis
24.
25. MANAGEMENT
• Children with FTT require 50% of Recommended Dietary Allowance
(RDA) of calories for catch up growth.
• Correction of any underlying disease
• Improvement in care-giver skills.
• Regular and effective follow up
• Treatment may also involve improving the family relationships and living
conditions.
26. • Feeding interval should not be greater than 4 hours & a maximum time allowed
for sucking should be 20 minutes.
• Eliminating distractive events
• Avoiding excessive fruit juices
• For older & young children meals should be last for 30 minutes, solid foods
should be offered before liquid, environmental distraction should be minimized.
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28. PROGNOSIS
Normal growth and development may be affected if a child fails to
thrive for a long time. Normal growth and development may
continue if the child has failed to thrive for a short time and the
cause is determined and treated.
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30. PREVENTION
Initial failure to thrive caused by physical defects cannot be prevented
but can often be corrected before they become a danger to the child.
Maternal education, emotional and economic support systems all
help to prevent FTT in those cases where there is no physical
deformity.
